MANAGEMENT OF PATIENT FOR RADICAL CANCER SURGERY

In a group of 279 medical and surgical patients 50 showed a lactate level > 5mEq/l. Five of the 50 patients developed the elevated lactate level during operation, the remaining 45 while a patient in the unit. The series was compared with an earlier series of 42 patients with lactate levels > 5mEq/l. The latter series included 27 operative patients and 15 nonoperative patients, primarily from the medical wards. The highest lactate level and the concomitant PaO₂ and acid base balance levels were employed for statistical analysis. In the total group of 92 patients with lactate levels > 5mEq/l there were 56 survivors and 36 non survivors. Several factors appear to play a role in the ultimate result. Lactate level > 10 mEq/l carries a serious prognosis. Mortality in the 18 patients with lactate > 10 mEq/l was 72% compared to a mortality of 31% in the 74 patients with lactate levels from 5 to 10 mEq/l. A lactate level > 5 mEq/l in the intraoperative patient has a better prognosis than a similar lactate level in the postoperative or medical patient. In 32 intraoperative patients the mortality was 9% compared to a mortality of 55% in the medical or postoperative patients. In septic patients with similar elevation of lactate levels prognosis may be influenced by intercurrent hemorrhage due to consumptiom coagulopathy and impaired respiratory function.